Lupus Medications and Treatments

09/19/2011 11:11 AM

11/02/2011 01:45 AM

Lupus Medications and Treatments

11/02/2011 01:45 AM

Medical treatment for lupus has made great strides within the last 50 years. This article will help you understand lupus treatments, lupus medications and side effects, and important lifestyle changes you can make to improve your lupus symptoms.

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Lupus -- also called systemic lupus erythematosus, or SLE -- might not have a cure, but it's a highly treatable condition. Lupus medications can help lower long-term risks and keep symptoms under control. According to the Lupus Foundation of America, 80% to 90% of people with lupus can expect a normal lifespan with good treatment.

Things used to be different. In the 1950s, most people with lupus died within a few years of diagnosis. What’s changed the prognosis? A combination of earlier diagnosis, better lupus medications, and more aggressive treatment, says Lisa Fitzgerald, MD, assistant professor of medicine at Harvard Medical School.

Now, the goal of lupus treatment is not just to reduce the symptoms, but to maintain full function, says Bonnie Lee Bermas, MD, director of the Brigham and Women's Hospital Lupus Center in Boston.

"I want people to have the same level of functioning that they had before they got sick," Bermas tells WebMD. "I want them to do all the things they used to do." With the right lupus medication and good care, many people can.

Lupus Medications

Lupus is mainly treated with medicine. The types of drugs that have been used to treat lupus include NSAIDs, corticosteroids and other immune system suppressing drugs, hydroxychloroquine, and the newest lupus drug, Benlysta.

Lupus medications work in different ways. What they have in common is that they all reduce swelling in the body, Fitzgerald says. Which drugs you need -- either alone or in combination -- depends on your particular case.

NSAIDs. These common drugs -- like aspirin, ibuprofen, naprosyn, or indomethacin, help reduce swelling, stiffness, and pain. For some people with very mild lupus, NSAIDs alone are enough to control symptoms.

Antimalarial drugs. Hydroxychloroquine (Plaquenil) is used to treat malaria, and researchers have found that this drug also helps with lupus flares. These drugs work well with mild to moderate cases of lupus. They can help ease lupus symptoms such as joint swelling and skin rashes. But hydroxychloroquine is not used alone for severe cases of lupus in which the kidneys or other organs are involved.
"Antimalarials have almost become like a daily multivitamin” for people with mild to moderate lupus," Fitzgerald says. The drugs’ side effects are generally mild, and these medicines may help prevent complications, improving a person’s long-term diagnosis.

Benlysta. Benlysta was approved in 2011 to treat lupus in combination with other lupus drugs. Although it does not benefit all patients with lupus, it helps some reduce doses of steroids, which can have troubling side effects. Benlysta, also called belimumab, is an antibody that recognizes and blocks a protein in the immune system that contributes to the immune system's attack on the body's own cells. The most common side effects are nausea, diarrhea, and fever.

Corticosteroids. Oral steroids – such as prednisone and prednisolone -- can be a lifesaving treatment for people with lupus. During serious lupus flares that affect organs such as the kidneys, high doses of steroids can quickly control symptoms.
However, steroids can also have troublesome or severe side effects, including weight gain, mood changes, and depression. In the long-term, these medicines can increase the risk of osteoporosis and other bone complications, infections, and weight-related conditions such as diabetes or high blood pressure.
"The goal with steroids is to get the person onto the lowest possible dose necessary to control symptoms," says Fitzgerald. As you get better, your rheumatologist will probably reduce the dose. Some people need long-term treatment with low-dose steroids; others can stop taking them altogether.
Steroids also come as a topical treatment, which can help treat skin rashes caused by lupus.

Immunosuppressive drugs. Because lupus is a disease caused by an overactive immune system, drugs that suppress the immune system can help relieve symptoms. These powerful drugs include azathioprine, cyclophosphamide, methotrexate, mycophenolate mofetil, and others. They are generally used in people who have severe lupus, when corticosteroids haven't worked or aren’t an option.
Immunosuppressives can cause serious side effects, because they block the body's ability to fight infection. If you take immunosuppressive drugs, you need to get medical attention at the first sign of an infection or illness.

New and experimental medications. A number of lupus medications -- many designed to target specific immune cells -- are being tested in studies. If you're interested, talk to your doctor about joining a clinical trial.

Other medications. Because lupus can affect so many different parts of the body, many people need other medications depending on their symptoms. These can include statins, diuretics, anticoagulants, drugs to strengthen bones, blood pressure medicines, antibiotics, stimulants, and others.

Keep in mind that it might take your rheumatologist some time to find the right lupus drug or combination. You may also need different medicines over time as your symptoms change.

"There is no one medication that helps all people with lupus," says Fitzgerald. "A drug might work well in some people and not at all in others. Unfortunately we don't have a way to predict who will benefit and who won't."

Coping With Lupus Medication Side Effects

As many people with lupus know, the list of possible side effects from lupus medications can be alarming. However, Bermas says that fears about side effects can get blown out of proportion. Although lupus drugs can have serious side effects, many are quite rare and most can be well managed,she says.

"People need to realize that when they're taking these medications, we know what side effects to look for," says Fitzgerald. "If they occur, we change the medication and it usually goes away."

Talk to your rheumatologist about your concerns. He or she will help you weigh the potential risks and benefits of your lupus medication accurately.

Other Lupus Treatments

Other than medicine, additional lupus treatments include:

Surgery and transplants. In severe cases, lupus can cause damage to the organs -- especially the kidneys. Some people develop kidney failure and need a transplant.

Experimental treatments. Scientists are studying other ways to treat lupus, such as stem cell transplants. Transplants would be limited to severe cases of lupus that haven't responded to other treatments. Ask your doctor if you're a candidate for an experimental treatment.

Complementary medicine. There's evidence that some supplements, such as DHEA or fish oil, might help people with lupus. But be sure to talk to your rheumatologist before taking any supplements. Supplements could interact with medicines or worsen lupus symptoms.

Lifestyle Changes for Lupus

Don't underestimate what you can do on your own for your lupus symptoms. Studies show that the condition can be improved by changes to your lifestyle.

Eat a healthy diet. Although no specific meal plan has been shown to help with lupus symptoms, aim for a diet high in fruits and vegetables and low in unhealthy fats. Ask your doctor to suggest additional dietary changes based on your personal health. For instance, if you have bone loss, your doctor may recommend increasing calcium and vitamin D. If you have kidney problems, your doctor might suggest eating a low-salt diet.

Exercise. Exercise is key if you have lupus. It can help improve your mood, boost energy, lower your risk of heart disease, and sharpen your thinking.

Reduce stress. In many people, stress can trigger flares. Use techniques like meditation, biofeedback, yoga, and breathing exercises to cut down on stress. Cognitive-behavioral therapy can help as well.

Rest. People with lupus might need more rest than the average person. If you can, build time for rest into the day and allow for 8 to 10 hours of sleep a night.

Working With Your Doctor

Because lupus can cause so many different symptoms, it can be tough to manage. You'll need the help of a few doctors at least -- a GP, a rheumatologist, and other experts depending on your lupus symptoms.

Even with good treatment, your symptoms are likely to fluctuate over time. Lupus is always unpredictable. That's why careful monitoring and regular check-ups are so important. As long as you get help quickly, many serious complications can be delayed or prevented.

"I think people who have just been diagnosed with lupus should be optimistic about treatment," Bermas tells WebMD. It's true that there are no miracle cures. Finding the right approach might take trial and error. But with patience -- and the help of your health care team -- the odds are good that you'll find a lupus treatment plan that works.